Clinics and Practice最新文献

{"title":"A Multidomain Prediction Model Integrating Myocardial Injury, Ventricular Function, and Inflammation for Short-Term Risk Stratification in Patients with NSTEMI.","authors":"Emir Bećirović, Minela Bećirović, Amir Bećirović, Amir Tursunović, Ajla Bajrić, Amil Softić, Adna Mujkić, Elma Mujaković, Admir Abdić, Lamija Ferhatbegović","doi":"10.3390/clinpract16080143","DOIUrl":"10.3390/clinpract16080143","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. <b>Methods</b>: This prospective observational cohort study included 170 consecutive adult patients with confirmed NSTEMI who were admitted to a Medical Intensive Care Unit and prospectively enrolled between February 2022 and January 2023. Clinical, routine biochemical, inflammatory, hematological, lipid, and echocardiographic data were collected during index hospitalization. High-sensitivity cardiac troponin I was measured at admission and again 24 h after hospitalization, with the 24 h value used as the principal marker of myocardial injury in the prediction analyses. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, recurrent myocardial infarction, ischemic stroke, urgent coronary revascularization, or hospitalization for worsening heart failure, within 3 months. Multivariable logistic regression, Cox regression, sequential prediction modeling, and internal bootstrap validation were performed. <b>Results</b>: MACEs occurred in 88 patients (51.8%). Twenty-four-hour hs-Troponin I, but not admission hs-Troponin I, was independently associated with MACEs (OR 1.57, 95% CI 1.09-2.26; <i>p</i> = 0.015) and a shorter time to the first MACE event (HR 1.38, 95% CI 1.07-1.78; <i>p</i> = 0.012). Lower left ventricular ejection fraction (LVEF) was also independently associated with adverse outcomes. The addition of 24 h hs-Troponin I, LVEF, and C-reactive protein improved discrimination from an AUC of 0.665 to 0.759 (optimism-corrected AUC, 0.717), with corresponding improvements in reclassification. A simplified multimarker score was independently associated with event-free survival (HR 2.36, 95% CI 1.53-3.64; <i>p</i> < 0.001). <b>Conclusions</b>: In patients admitted to a medical intensive care unit with NSTEMI, the integration of 24 h hs-Troponin I, LVEF, and C-reactive protein improved short-term risk prediction beyond that of clinical variables alone. A practical multimarker model based on routinely available parameters identified patients at increased risk of adverse cardiovascular outcomes during early follow-up.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproducibility of Mandibular Cortical Index Classification Among Dental Examiners and a Single Generative AI Platform: An Observer Agreement Study.","authors":"Keisuke Seki, Minori Kashima, Taiki Akiyama, Atsushi Kobayashi, Ko Dezawa, Yoshimasa Takeuchi, Mika Furuchi, Atsushi Kamimoto","doi":"10.3390/clinpract16080142","DOIUrl":"10.3390/clinpract16080142","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The mandibular cortical index (MCI) is a valuable screening tool for osteoporosis on dental panoramic radiographs, but its assessment is subject to inter-examiner variability. This study evaluated the reproducibility and inter-rater agreement of MCI classification by a closed-source generative AI tool (NotebookLM, Google) compared with eight dentists of varying clinical experience. <b>Methods:</b> One hundred panoramic radiographs were classified according to the three-category MCI in two sessions held at least two weeks apart. Intra-examiner reliability, inter-examiner agreement, and agreement with a reference radiologist were assessed using linearly weighted kappa coefficients. The study was designed as a descriptive reliability study rather than a formal equivalence trial. <b>Results:</b> The intra-examiner reliability of the AI was exceptionally high (κ = 0.987). However, agreement between the AI and the dentists remained at \"slight agreement\" or lower (κ < 0.2) for every pairing, with 95% confidence intervals that included zero; no formal global hypothesis test was performed, and these individual interval estimates should not be interpreted as proof of the absence of agreement beyond chance. A \"two-level discrepancy,\" in which the AI interchanged Class 1 (normal) and Class 3 (severe), occurred in 10-18% of cases. The dentists showed a possible learning effect, with inter-examiner agreement improving between sessions. <b>Conclusions:</b> Despite the high reproducibility of the NotebookLM configuration evaluated in this study, agreement with the dentists remained at \"slight\" or lower (κ < 0.2) in MCI classification. As classifications were not validated against bone mineral density or an adjudicated reference standard, these findings concern reproducibility and agreement rather than diagnostic or screening performance and characterize a single LLM-based platform rather than generative AI in general.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myoprotective Fat-Loss Phenotypes in Obesity-Associated Type 2 Diabetes: A 12-Month Real-World Cohort Study of Metformin-Based Treatment Regimens.","authors":"Ioana Bujdei-Tebeică, Anca Mihaela Pantea-Stoian, Doina Andrada Mihai, Simona Diana Ștefan, Cristian Serafinceanu","doi":"10.3390/clinpract16080141","DOIUrl":"10.3390/clinpract16080141","url":null,"abstract":"<p><p><b>Background/Objectives</b>: In obesity-associated type 2 diabetes (T2DM), therapeutic benefit increasingly requires assessment of not only HbA1c and total body weight, but also the composition and functional quality of weight change. We evaluated a myoprotective fat-loss phenotype, defined as a reduction in adiposity accompanied by preservation of lean mass and handgrip strength. <b>Methods</b>: This secondary patient-level analysis included 166 adults with T2DM who completed 12 months of follow-up without changing treatment in a real-world tertiary diabetes cohort. Patients received metformin alone or metformin combined with a sulfonylurea, a DPP-4 inhibitor, an SGLT2 inhibitor, a GLP-1 receptor agonist, or insulin. Body composition was assessed by bioimpedance and muscle function by handgrip dynamometry. The primary phenotype required a reduction in fat mass ≥5%, a loss of lean mass <3%, and a decrease in handgrip ≤1 kg. Phenotype distributions were compared between treatment groups; patient-level associations and adjusted contrasts were explored using correlation analyses and baseline-adjusted regression models with robust HC3 standard errors. <b>Results</b>: Fat-mass reduction ≥5% occurred in 58/166 patients (34.9%), lean-mass preservation in 129/166 (77.7%), and handgrip preservation in 143/166 (86.1%). The complete myoprotective phenotype was present in 35/166 patients (21.1%) and differed significantly across treatment groups (χ² = 131.58; permutation <i>p</i> < 0.0001). It was most frequent in the GLP-1 receptor agonist group (13/23; 56.5%) and the SGLT2 inhibitor group (12/25; 48.0%), less frequent with metformin monotherapy (9/46; 19.6%) and DPP-4 inhibitors (1/17; 5.9%), and absent in the sulfonylurea and insulin groups. GLP-1 receptor agonists showed the greatest crude fat-mass loss, whereas lean-mass loss, skeletal-muscle-mass change, and handgrip change did not differ significantly across groups after false-discovery-rate correction. <b>Conclusions</b>: Myoprotective fat-loss phenotypes can be identified in obesity-associated T2DM using body composition and handgrip measures. These observational findings support the assessment of the quality, not just the magnitude, of weight loss in diabetes care and require validation in larger prospective studies.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bringing the Line Home: A Perspective on Establishing At-Home PICC (Peripherally Inserted Central Catheter) Insertion in Oncology Patients.","authors":"Orestis Ioannidis, Antonia Aikaterini Bourtzinakou, Elissavet Anestiadou, Evangelia Ioannidou, Konstantinos Siozos, Georgios Gemousakakis, Stefanos Bitsianis, Savvas Symeonidis, Efstathios Kotidis, Manousos Georgios Pramateftakis, Ioannis Mantzoros, Stamatios Angelopoulos","doi":"10.3390/clinpract16080138","DOIUrl":"10.3390/clinpract16080138","url":null,"abstract":"<p><p><b>Background and Objectives:</b> Vascular access in cancer patients with limited mobility remains a persistent clinical challenge, although both devices and insertion methods have improved considerably. We present our clinical experience with at-home PICC placement, supported by real-world data from routine practice, in oncology patients unable to attend hospital care, exploring its feasibility, safety, and practical applicability. <b>Materials and Methods:</b> All PICC insertions were performed at patients' bedside by a trained surgeon using sterile technique. A single- or double-lumen PICC catheter was inserted under ultrasound guidance, magnetic tracking, and intracavitary ECG confirmation to secure optimal venous entry and accurate tip positioning. <b>Results:</b> A total of 28 PICC lines were successfully inserted in 26 oncologic patients. Two patients required catheter re-insertion, one following accidental removal and one due to infection. In 26 of 28 cases (92.9%), insertions were completed on the first attempt, while two cases required a second attempt. Insertion in the Green Zone per the ZIM classification was achieved in 26 of 28 cases (92.9%), and only two required insertions in the Yellow Zone. The basilic vein was chosen in 75% of patients. A total of 23 single-lumen and five double-lumen catheters were inserted. In terms of complications, four cases of systemic infection occurred more than 15 days after insertion and were not considered insertion-related; two patients developed localized edema requiring anticoagulation, and four catheter occlusions were managed conservatively. <b>Conclusions:</b> At-home PICC placement appears to be a feasible and clinically applicable approach when performed by qualified and credentialed professionals. These observations, derived from real-world clinical experience, suggest a potential role for this model in selected patient populations. Using proper sterile technique and real-time tip confirmation tools, this intervention may contribute to improved continuity of care and reduced hospital visits in selected patients. These observations suggest a potential role for expanding outpatient vascular access programs in selected patient populations.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Timing for Intrauterine Device Insertion During the Menstrual Cycle: A Comparative Study of Pain, Bleeding, and Postprocedural Outcomes.","authors":"Lucian Șerbănescu, Sebastian Mirea, Vadym Rotar, Ștefan-Adrian Vrîncianu, Elena Mocanu, Maria Fulina, Stere Popescu, Cosmin Nișcoveanu, Radu-Andrei Baz","doi":"10.3390/clinpract16080139","DOIUrl":"10.3390/clinpract16080139","url":null,"abstract":"<p><p><b>Background:</b> Intrauterine device (IUD) insertion is a highly effective contraceptive procedure but is frequently associated with pain and bleeding, which may negatively influence patient acceptance and continuation rates. Although traditionally performed during menstruation, the optimal timing of insertion within the menstrual cycle remains uncertain, with limited data regarding patient-centered outcomes. <b>Objective:</b> The aim of this study was to evaluate the impact of menstrual cycle timing on pain, intra-procedural bleeding, and postprocedural outcomes in women undergoing IUD insertion. <b>Methods:</b> A comparative observational study was conducted including 200 parous women aged 20-40 years. Participants were consecutively enrolled and classified into two groups according to the day of the menstrual cycle at presentation for IUD insertion: Group A (days 3-7 of the menstrual cycle) and Group B (days 10-14). All procedures were performed by the same experienced gynecologist using a standardized technique. Pain was assessed using a Visual Analog Scale (VAS), intra-procedural bleeding was graded on a 0-3 scale, and postprocedural outcomes included analgesic use and bleeding characteristics. Statistical analysis was performed using independent t-tests and chi-square tests. <b>Results:</b> Baseline characteristics were comparable between groups (<i>p</i> > 0.05). Mean pain scores were significantly lower in Group B compared to Group A (3.1 ± 1.2 vs. 5.8 ± 1.4, <i>p</i> < 0.001). Intra-procedural bleeding was also significantly reduced in the mid-cycle group, with higher rates of minimal or no bleeding (85% vs. 20%, <i>p</i> < 0.001). The need for postprocedural anti-inflammatory medication was significantly lower in Group B (22% vs. 76%, <i>p</i> < 0.001). Additionally, postprocedural bleeding duration and intensity were reduced in the mid-cycle group. <b>Conclusions:</b> IUD insertion performed during the mid-cycle phase was associated with significantly better tolerability, including reduced pain, less bleeding, and decreased need for analgesia. While current guidelines allow flexible timing, these findings suggest that mid-cycle insertion may be associated with improved patient comfort when clinically feasible to improve patient experience without compromising access to contraception. Further randomized studies are warranted to confirm these results.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Interplay of Quality of Life and Satisfaction with Nursing Care in Cancer Patients: A Narrative Review.","authors":"Efthymia Vlachothanasi, Ioanna Tsatsou, Theocharis I Konstantinidis, Maria Saridi, Evangelos C Fradelos, Georgios Goumas, Pavlos Sarafis","doi":"10.3390/clinpract16080140","DOIUrl":"10.3390/clinpract16080140","url":null,"abstract":"<p><p>This narrative review explores the interconnected relationship between quality of life (QoL) and satisfaction with nursing care (SNC) among cancer patients, recognizing that cancer's burden extends beyond survival and significantly affects physical, psychological, and social well-being. A non-systematic search of PubMed, CINAHL, Scopus, and Google Scholar (2000-2025) identified relevant literature using keywords related to oncology nursing, QoL, SNC and patient satisfaction. Inclusion criteria encompassed peer-reviewed studies (quantitative, qualitative, and reviews) involving adult cancer populations and validated assessment instruments. Pediatric and non-nursing studies were excluded. Both QoL and SNC are critical outcomes in cancer care. QoL is an individual's subjective perception and SNC reflects the patient's subjective evaluation of how well nursing services align with their expectations, encompassing empathy, competence, and responsiveness. Research consistently demonstrates a strong positive association between high SNC and superior QoL outcomes, particularly through effective pain and symptom management, reducing psychological distress, and fostering patient empowerment. This relationship, however, is moderated by factors such as the patient's disease stage, the type of care (hospital vs. palliative/home care), and organizational deficits like high nurse workload, which can undermine the delivery of high-quality care. Ultimately, ethical nursing practices are crucial for translating professional duty into positive patient experiences that are favorably linked with both SNC and QoL outcomes for cancer patients.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gambling Disorder as a Behaviorally Driven Systemic Medical Condition: From Reward Circuitry to Multi-System Morbidity.","authors":"Martina Ballerio, Piercarlo Minoretti, Enzo Emanuele","doi":"10.3390/clinpract16080137","DOIUrl":"10.3390/clinpract16080137","url":null,"abstract":"<p><p>Historically framed as a behavioral addiction, gambling disorder (GD) has had its somatic dimension neglected by standard clinical evaluation. This is a narrative, hypothesis-generating review focusing on the somatic aspects of GD. Cross-sectional and prospective evidence increasingly shows a somatic phenotype distributed across four axes: cardiovascular (hypertension, angina, stroke, acute stress-induced cardiac events), metabolic (obesity, type 2 diabetes, chronic liver disease), sleep-related (insomnia, poor sleep quality, daytime sleepiness), and-as an emerging and insufficiently characterized dimension-neurological (clustering with seizures and frontal lobe epilepsy). Three candidate biological systems may translate this exposure into multi-system physiology: (i) a hyperreactive mesostriatal reward circuit hypothesized to sustain a behavioral cluster of smoking, hazardous alcohol use, low physical activity, and unhealthy diet; (ii) an integrated stress response postulated to shift from acute hyperreactivity to chronic basal cortisol blunting and reduced vagal tone; and (iii) putative alterations in peripheral neurotrophic signaling and frontal-callosal structure, marked by elevated peripheral brain-derived neurotrophic factor and by frontal-callosal white-matter alterations-with cumulative allostatic load serving as a conceptual integrating frame. We propose that GD can be a behaviorally driven systemic medical condition, warranting internal medicine involvement alongside addiction psychiatry. Within this framework, glucagon-like peptide-1 receptor agonists emerge as an exploratory therapeutic hypothesis warranting dedicated evaluation in GD, given their action on the mesolimbic reward substrate and phase 3 evidence in adjacent cardiometabolic, hepatic, and sleep conditions.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nontherapeutic INR After Hospital Discharge: A Repeated-Measures Analysis of Warfarin-Treated Patients and Potential Drug-Drug Interactions.","authors":"Kanthida Methaset, Pattamawan Kosuma, Arom Jedsadayanmata","doi":"10.3390/clinpract16080136","DOIUrl":"10.3390/clinpract16080136","url":null,"abstract":"<p><p><b>Background:</b> Warfarin remains widely used in specific clinical situations. Its management is complicated by multiple factors that affect anticoagulant response, particularly during the early period after hospital discharge. This study examined the prevalence, patterns, and factors associated with nontherapeutic international normalized ratio (INR) among patients discharged on warfarin from a tertiary-care hospital. <b>Methods:</b> Electronic health records of adult patients discharged home with warfarin who had at least one INR measurement within 90 days (<i>N</i> = 1222) were retrospectively analyzed. Nontherapeutic INR was defined as INR outside the therapeutic range: 2.5-3.5 for mitral valve replacement and 2.0-3.0 otherwise. All available INR measurements were included. Major warfarin potential drug-drug interactions (pDDIs) were defined as DDIs with major severity according to the Micromedex^® database. Factors associated with nontherapeutic INR were examined using repeated-measures generalized estimating equations (GEEs), with generalized linear mixed models (GLMMs) as confirmatory analyses. <b>Results:</b> Of 3704 INR measurements within 90 days after discharge, 49.4% were subtherapeutic, while 30.5% were therapeutic and 20.1% were supratherapeutic. The proportion of therapeutic INR values did not show a substantial improvement over time. In GEEs, discharge from surgical service (adjusted odds ratio (aOR) 1.24, 95%CI: 1.05-1.48, <i>p</i> = 0.014) and presence of major warfarin pDDIs at discharge (aOR 1.36, 95%CI: 1.11-1.67, <i>p</i> = 0.003) were associated with nontherapeutic INR. GLMM analyses produced consistent results with the GEE model. <b>Conclusions:</b> Suboptimal INR control was prevalent within 90 days post-discharge. Discharge from surgical services and presence of major warfarin pDDIs at discharge were associated with nontherapeutic INRs. Major warfarin pDDIs may serve as markers of medication complexity at discharge and may help identify patients requiring closer anticoagulation monitoring.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apert Syndrome: Oral, Maxillofacial and Dental Management-A Narrative Clinical Review.","authors":"Nikolaos G A Kolomvos, Thomai Papadaki, Gregoris Venetis","doi":"10.3390/clinpract16070135","DOIUrl":"10.3390/clinpract16070135","url":null,"abstract":"<p><p>Apert syndrome is a rare genetic disorder characterized by premature fusion of the cranial sutures, syndactyly of the extremities, and distinct craniofacial deformities. The condition results from mutations in the FGFR2 gene, which disrupt normal craniofacial growth and lead to complex functional and morphological abnormalities. Patients with Apert syndrome commonly present with stomatognathic abnormalities, which significantly affect oral function and facial development. The management of Apert syndrome requires a multidisciplinary therapeutic approach. Surgical treatment strategies are typically staged according to the patient's age and clinical severity. Early interventions focus on cranial vault expansion procedures, such as fronto-orbital advancement and posterior vault distraction osteogenesis, aiming to relieve intracranial pressure and improve cranial morphology. During childhood and adolescence, midface advancement techniques are commonly performed to address midfacial hypoplasia and associated functional impairments. Early diagnosis and appropriate surgical planning play a crucial role in preventing complications and improving the functional, aesthetic, and psychosocial outcomes of patients with Apert syndrome. This narrative review summarizes current evidence while highlighting areas of ongoing controversy, particularly regarding surgical sequencing, orthodontic management and the integration of digital technologies into multidisciplinary care.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Indicators in Lithuania: A Descriptive Analysis of Their Contextual Relevance to Health Literacy.","authors":"Sonata Čerkauskaitė, Alina Liepinaitienė","doi":"10.3390/clinpract16070134","DOIUrl":"10.3390/clinpract16070134","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Chronic non-communicable diseases remain one of the main public health problems. Increasing multimorbidity and the importance of health literacy (HL) emphasize the need for a comprehensive assessment of health indicators. The aim of this study was to assess the main health indicators of the Lithuanian population and trends in the use of healthcare services and to discuss the relevance of these indicators in the context of HL, based on the links between HL and these indicators described in the scientific literature. <b>Methods</b>: A retrospective longitudinal descriptive study was performed using publicly available Lithuanian population health statistics of 2005-2024. Mortality, morbidity, avoidable hospitalizations, subjective health assessment, and utilization of healthcare services and preventive programs were analyzed using descriptive statistical analysis. HL was not directly measured but was used as a conceptual framework for interpreting the findings. <b>Results</b>: In Lithuania, the highest mortality rate is due to cardiovascular diseases (CVDs) (~50.8%). CVD and infectious diseases also dominate the structure of avoidable hospitalizations, and their rates vary greatly across municipalities, being higher in less urbanized areas. The assessment of the population's health is improving over time, but gender differences remain in the use of healthcare services and preventive programs. <b>Conclusions</b>: The findings demonstrate a high burden of chronic diseases and regional disparities in healthcare utilization in Lithuania. HL may provide a useful context for interpreting these findings, although it was not directly assessed. Future studies should directly evaluate HL and its association with health indicators in the Lithuanian population.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}